340B Drug Pricing Program costing employee health plans $5B per year
“Hospitals realized they could buy heavily discounted drugs and resell them to insured, middle-class patients at huge markups.”
By Dan Crippen
An obscure, supposedly free federal program is blowing a hole in state budgets — by depriving state governments of billions in corporate tax revenue and inflating costs for their public employee health plans.
The culprit is the 340B Drug Pricing Program, which Congress established in 1992 to help safety-net hospitals. Once enrolled, qualifying hospitals and clinics and their partner pharmacies — collectively called “covered entities” — can purchase medicines directly from drug manufacturers or wholesalers at roughly 50% discounts.
Congress expected only about 90 hospitals to participate. Today, more than 2,600 hospitals are enrolled.
This explosive, unintended growth is the result of the program’s lax requirements. Covered entities are not required to expand charity care or even report how they use their 340B earnings.
Hospitals realized they could buy heavily discounted drugs and resell them to insured, middle-class patients at huge markups. In some cases, hospitals have charged cancer patients nearly ten times what they paid to acquire the drug.
The opportunity to upcharge patients has proven irresistible and fueled the program’s bloat. In 2023, covered entities purchased $124 billion worth of medicines — but only paid $66 billion, meaning they received roughly $58 billion in discounts.
Numerous audits have revealed that many hospitals use the funds to subsidize expansion in affluent neighborhoods, rather than support low-income or uninsured patients.
This perverse behavior harms state taxpayers. Because most 340B hospitals are technically non-profits, their earnings aren’t taxed. As a result, states collect about $3.5 billion less in corporate income tax and other tax revenue than they otherwise would. That’s money not available for public health, education, infrastructure, or employee benefits.
The 340B program hurts states in other ways, too.
The program incentivizes hospital systems to acquire independent clinics — which don’t qualify for 340B — and designate them as “child sites” that subsequently become eligible for 340B.
This leads to higher healthcare spending, since care at hospital-owned sites is more expensive than at clinics and independent practices.
Care at 340B hospitals tends to be more expensive than care at competing hospitals, too. The average per-patient prescription spending at 340B hospitals is 150% higher than non-340B hospitals.
All told, large employers and their workers spend over $5 billion more per year on health care as a result of 340B. Every extra dollar that businesses spend on health care is a dollar that’s deducted from their taxable income.
The program also inflates costs for state employee health plans. Utah recently found that its Public Employees Health Program is losing out on $3.9 million in rebate savings due to 340B.
Some state lawmakers are unwittingly compounding the damage by making it easier for pharmacies to contract with 340B hospitals and clinics.
Instead of boosting care for poor patients, 340B drains public resources while enriching large hospital systems. Reform is desperately needed.
Dan Crippen is the former Director of the Congressional Budget Office. This piece originally ran in RealClearHealth.
1 Civil Engineer, 1 Electrical Engineer and 1 Certified Public Accountant
By San Francisco Bay Area Rapid Transit District
BART is recruiting volunteer candidates to fill three vacant seats on the Measure RR Bond Oversight Committee. The committee provides diligent and public oversight of the expenditure of funds from bond sales associated with Measure RR, which is a $3.5 billion bond measure approved by BART District voters in 2016 to rebuild the system’s core infrastructure. Members of the Bond Oversight Committee represent a diversity of expertise, geography, and demographic characteristics. BART is looking for candidates to fill the electrical engineer, civil engineer, and Certified Public Accountant seats on the committee. All committee members are unpaid volunteers.
Candidates must live in either Alameda County, Contra Costa County or San Francisco City and County.
Source: BART
About Measure RR
Voters approved Measure RR, a $3.5 billion bond, in November 2016. The bond proceeds fund a portfolio of projects including replacing 90 miles of severely worn tracks, repair tunnels damaged by water intrusion and upgrade the aging train control system. Learn more at bart.gov/rebuilding/projects.
About the Committee
The independent Measure RR Bond Oversight Committee consists of five professionals in the areas of engineering, auditing, public finance, construction project management, and two members from the League of Women Voters. Learn more at bart.gov/bondoversight.
Committee Responsibilities
Members of the Committee are responsible for the following:
• Assess how bond proceeds are spent.
• Assess that work is completed in a timely, cost effective and quality manner.
• Communicate its findings and recommendations to the public.
• Publish an annual report.
Source: BART
Time Commitment
The minimum time commitment is about 10 to 15 hours per year. There are typically four in person meetings annually, which are open to the public
Compensation
Committee members are volunteers. However, BART will compensate members for their travel on BART to and from meetings.
Source: Diana Becton for District Attorney campaign
CCC Deputy Sheriff’s contribute $50K;Antioch Police Officers Association explains reasons for $5,000 contribution
By Allen D. Payton
In a post on Facebook on Monday, July 28, 2025, the Becton for DA campaign surprisingly announced new support for her recall from the Deputy Sheriff’s Association and two other “major law enforcement associations.” According to recall organizer Gwynn Gabe the other two are the Antioch Police Officers Association (APOA) and Concord Police Officers Association.
“She’s been keeping track of the people who are giving us money,” he added.
The post by “Team Becton” reads “They’ve launched their attack. Now it’s our turn,” in the header with the statement below:
“The recall against District Attorney Diana Becton just escalated.
Three major law enforcement associations, including the Contra Costa County Deputy Sheriff’s Association, just poured tens of thousands into the recall effort—including a single $50,000 donation. Even more telling? They’ve hired the strategist behind the recalls of DAs in San Francisco and Alameda County.
This isn’t just a warning. This is a coordinated, well-funded effort to undo the will of the voters and take Contra Costa backwards.
But here’s the truth they don’t want you to remember: we’ve already won twice. And with your help, we will again, because here’s what they’re underestimating: you. Us. This community.
This is not the time to sit back. We need you on the front lines —because what’s at stake is bigger than any one election. It’s about protecting real public safety solutions, and standing up to those who want to take us backward. DA Becton has stood up for equity, justice, and real public safety. Now we must stand up for her.”
It then offers ways for opponents of the recall to “Take Action Now” including volunteering and donating through the Act Blue campaign fundraising website for Democrats currently under investigation for possible fraudulent political contributions.
The APOA Board issued the following statement about their contribution of $5,000 to the campaign to recall Becton: “The APOA was approached by members of the recall movement who asked if we would be willing to support them in their efforts to recall the DA. After careful consideration, we agreed as a board to support this endeavor in hopes that this would ultimately lead to a more transparent DA’s office that holds criminals accountable and keeps our streets safe. Whatever the outcome, we know the officers represented by the APOA will continue to work hard to keep our community safe and have a great working relationship with the DA’s office.”
Recall organizers have until 5:00 PM on Thursday, September 25, 2025, to submit 72,556 valid signatures to qualify the effort for the ballot.
Antioch PD, Contra Costa Sheriff’s Dep’t among 148 Cannabis Tax Fund Grant Program recipients
CCC Sheriff Forensic Services Division will use funds for toxicology crime lab
By Tami Grimes, CHP Public Information Officer
SACRAMENTO – The California Highway Patrol (CHP) today announced more than $35 million in grant funding to 148 California law enforcement agencies, crime laboratories, local government agencies and nonprofit organizations to help address the dangers of driving under the influence of alcohol and/or drugs.
“As the legal cannabis market continues to grow, so do the state’s efforts to ensure Californians are recreating responsibly. By supporting the organizations that enforce and amplify our laws on the ground, we can keep everyone safer,” said Governor Gavin Newsom.
The grants from Proposition 64, the Control, Regulate and Tax Adult Use of Marijuana Act, assigned the CHP the responsibility of administering grants for education, prevention and enforcement programs aimed at helping communities tackle impaired driving. Additionally, funds are available for crime laboratories that conduct forensic toxicology testing. The funding for these grants comes from a tax on the sale of cannabis and cannabis products in California.
Source: CHP
“This funding represents a major step forward in our ongoing mission to save lives and prevent impaired driving,”said CHP Commissioner Sean Duryee. “With over $35 million going to nearly 150 public safety partners across the state, we’re expanding our reach like never before. These resources will help those on the frontlines keep California’s roads safer for everyone.”
These funds will go towards a variety of activities. One hundred twenty-six recipients of law enforcement grants will use the funding to combat impaired driving in their communities, including Antioch, Danville, Pinole, Pleasant Hill, Richmond and San Ramon Police Departments. The funds will also support drug recognition evaluator training to improve the identification of drug-impaired drivers, as well as public outreach campaigns, including educational presentations and community events.
Eleven recipients of education grants will use the funds to inform local communities about impaired driving laws while highlighting the dangers of driving under the influence of alcohol and/or drugs.
Source: CHP
Seven recipients of two-year toxicology crime laboratory grants, including the Contra Costa County Sheriff’s Department Forensic Services Division, will use the funds to eliminate backlogs in analyzing forensic science evidence and to purchase or upgrade laboratory equipment to enhance testing capabilities.
Four recipients of two-year medical examiner’s and coroner’s office grants will use the funds to improve and advance data collection in cases involving driving under the influence of alcohol and/or drugs.
With the passage of Proposition 64, the Control, Regulate, and Tax Adult Use of Marijuana Act (AUMA), California voters mandated the state set aside funding for the California Highway Patrol (CHP) to award grants to local governments and qualified nonprofit organizations, as described in Revenue and Taxation Code Section 34019(f)(3)(B).
The Cannabis Tax Fund Grant Program marks an important step toward reducing impaired driving crashes, increasing public awareness surrounding the dangers of impaired driving, and making California’s roadways a safer place to travel.
The application process for future grant funding is expected to reopen in early 2026. More information is available on the CHP website at CHP’s Cannabis Tax Fund Grant Program.
The mission of the CHP is to provide the highest level of Safety, Service, and Security.
Presented by Antioch Business Collaborative and Working Solutions
Calling all entrepreneurs in the City of Antioch!
If you are looking to finance your small business but don’t know where to start, join Working Solutions on Zoom this Thursday, June 26 at 4 PM for a free Capital Readiness workshop! Learn how to access funding with the right mindset and documents, and what makes a business approvable for a loan. Register at bit.ly/antioch-loan-ready.
Working Solutions is pleased to partner with the City of Antioch to deliver financial and technical assistance to Antioch entrepreneurs through the Antioch Business Collaborative. See below for funding opportunities, upcoming workshops, or to get started with one-on-one pre-loan support.
If you’re ready to get started and need loan application support, find us in person at the Antioch Community Center every Tuesday from 9 AM-12 PM. Learn more at workingsolutions.org/antioch.
Almost half of cuts from Police Department staffing, overtime savings
Plus, $165.3 million 5-Year Capital Improvements budget and $2.4 million in federal community funds
By Allen D. Payton
Following all the special budget session meetings over the past several months, the Antioch City Council, during their meeting Tuesday night, June 24, 2025, is expected to approve the 2025-26 budget with over $11.5 million in spending cuts and using $5 million from the Budget Stabilization Fund. The City was facing a $24.3 million deficit for the coming fiscal year and if the budget is approved as recommended, will have a net deficit of $7.7 million which will be covered from reserves.
Almost half of the savings, $5.5 million, will be in the Police Department budget from Vacancy Savings and Overtime Reductions. UPDATE: That’s due to the current staffing vacancies of approximately 30 sworn officers and the chief informing the council that they expect to add 15 more officers in the next year. So, instead of determining the savings from the staff vacancies during a mid-year budget review and spending the one-time funds on other City budget items, the council chose to account for it in the budget up front to reduce the deficit.
In spite of the cuts, future fiscal years still show the City facing projected deficits of $10,629,642 in 2026-27 and $25,396,400 in 2028-29.
The proposed budget also includes an allocation from the Measure W 1% City sales tax of 70-15-15 or 70% for Police, 15% for Quality of Life and 15% for Youth. (See page 6 of the Budget)
According to the City staff report for item #5, “Since March, City Council and staff have been diligently scrutinizing the budget to close a starting point fiscal year 2026 deficit of $24,270,240. Initially, staff was able to shave $8,603,792 from that number, for a fiscal year 2026 deficit of $15,666,448 as presented at the March 4th budget session. Upon further collaboration with the Council, City Manager and departments as we moved through the exhaustive budget process, and through a series of further adjustments, a General Fund budget with a net deficit of $7,737,331, after a $5M infusion from the Budget Stabilization Fund.”
In addition, under item #3 the Council is expected to approve the Five-Year Capital Improvement Program budget for 2025-2030 for Community Facilities, Parks & Trails, Roadway Improvements, Traffic Signals, Wastewater & Storm Drain System and the City’s Water System. Currently, there are $163.3 million of projects in progress which includes $6,238,209 of projects that the Council added to the list.
Finally, in other budget action, under item #4 the Council will consider approving the recommendations of the City Council’s Community Development Block Grant (CDBG) Subcommittee for a total of $2,369,318 in federal funds for the coming fiscal year. Mayor Pro Tem Louie Rocha, representing District 2, and Councilwoman Tamisha Torres-Walker, representing District 1, served on the CDBG Subcommittee for this funding cycle.
The meeting begins at 7:00 PM in the Council Chambers inside City Hall at 200 H Street, in historic, downtown Rivertown. It can be viewed via livestream on the City’s website, on Comcast Local Cable Channel 24 or on AT&T U-verse Channel 99.
The Contra Costa Water District Canal Replacement Project includes 20 miles of the waterway. Photo: CCWD
Lake Shasta is source of all water, Los Vaqueros Reservoir will not be expanded, CoCoTax members learn
By Allen D. Payton
During the Contra Costa Taxpayers Association Members and Leaders monthly luncheon in May, Contra Costa Water District Board President, Ernesto Avila provided an update on the district’s current work and plans. They include repairing 20 of the 48-mile canal at a cost of $1 billion, keeping water rates as low as possible and expanding service to keep up with growth.
The district includes the Central County cities and communities of Martinez, Pleasant Hill, Concord, Clayton, Pacheco, Clyde, Port Costa and portions of Walnut Creek, and in East County, the cities and communities of Pittsburg, Antioch, Oakley, Bay Point, and portions of Brentwood.
CCWD Board President Ernesto Avila provides an update during the CoCo Taxpayers Association luncheon on May 23, 2025. Photo: Allen D. Payton
Half of the district’s water is provided to treated water customers and the other half to raw water customers, Avila stated and then spoke about ensuring adequate “water supply during disasters such as fire and earthquake emergencies.”
“When PG&E outages occur all of our tanks go full,” he shared. “Water only stays sweet for six to seven days to meet the water quality requirements of the state.”
“Lake Shasta is where we get all of our water from through the Central Valley Project,” he continued. “It’s currently 94% full.”
The district owns Los Vaqueros Reservoir for storage, which is currently 93% full. But “we can’t just draw water whenever we want,” Avila stated. “All of our intakes are screened to protect fish.”
“We are out of our drought,” Avila added. However, “during the drought there were no constraints on water supply for development and growth.”
Source: CCWD
Canal Replacement Program
There have been “landslides on the west side of the canal and repairs can cost millions,” he stated and spoke of the district’s “Canal Replacement Program” which will cost “$1 billion”.
“Nobody likes to raise rates,” Avila continued. “We’ve replaced four miles, so far and have 16 miles to go. It will be a pipeline”
Asked what happens to the pipe during an earthquake he said, “If it’s an older pipe, it will probably crack. We’re looking at a very ductile pipe that can move easily.”
Avila then spoke about providing enough water to meet the demands of residential growth including “redevelopment of the Concord Naval Weapons station” where “15,000 homes” are projected to be built.
“Ten percent of the district’s water is provided through recycling,” he stated. “We want to bump that up to fifteen percent.”
Budget & Water Costs to Users
“Energy costs have been the greatest increases from 2020 to 2024, medical coverage is second greatest,” he shared. Those are followed by “pension and OPEB (other post employee benefit) liabilities.”
“The average customer spends about $3.00 per day for water,” Avila stated. “The cost is 1.3 cents per gallon per day.”
He compared that to EBMUD rates which are at 2.0 cents per gallon.
Contra Costa Water District Production Costs. Source: CCWD
According to the slide show from his presentation, costs to the district for water production include the following:
INVESTMENTS IN INFRASTRUCTURE – Pipeline Renewal, Canal Replacement, Water Treatment Plant Upgrades;
PURCHASED WATER
WATER SUPPLY AND RESOURCE PROTECTION – Water Supply Planning, Watershed Management, Recreation;
SYSTEM OPERATIONS & MAINTENANCE – Water Treatment, Water Delivery, Leak Inspection and Repair;
ADMINISTRATION – Human Resources, Safety, Accounting and Payroll;
CUSTOMER CARE – Customer Service, Billing, Water Efficiency Support, and Public Affairs; and
COMMUNITY EDUCATION AND WORKFORCE DEVELOPMENT K-12 Water Education and Field Trips, and Internships.
The district has an AAA Bond Rating which keeps interest costs on bonds down, Avila shared.
He was then asked about “money going to DEI programs. I this something you should be doing anymore?” Avila responded, “there are three employees dedicated to it. There are 317 employees which is 30-40% of the budget We have one person in Human Resources dedicated to it. We have a $200 million per year budget. Not even one percent is dedicated to it.”
“It’s about trying to enhance the culture for our employees to work together better,” he added. “We review it every six months. Our Master Plan is on the website.”
Asked about “EPA clean water requirements getting tougher each year” Avila spoke about “unfunded mandates we have to comply with. We work with various associations and collaborate on a national level as regulations are mostly at the federal level.”
“Our biggest concern is the issue of diminishing return on conservation,” he explained. “During the drought, people in our area reduced use by 25 percent while Southern California only reduced 2-3 percent.”
According to the chart in Avila’s presentation total water use has actually decreased over the past 17 years even though the population has significantly increased.
Source: CCWD
No Los Vaqueros Capacity Increase Due to Too Much Cost and Regulation, Offline for Too Long
Asked about increasing capacity at Los Vaqueros, Avila said, “The district spent $10 million on raising the…reservoir, for a cost/benefit analysis funded by the state. It was over subscribed with more customer demand than supply, 250,000 versus 120,000 acre feet.”
“But with so many constraints on pumping water into the reservoir, demand dropped to 50,000 acre feet then to zero,” he continued. “The cost increase with inflation went from $800 million to $1.6 billion, mainly from more material and labor cost increases, plus, engineering costs.”
Finally, Avila shared, “Los Vaqueros Reservoir would have had to be offline for six to seven years. It just wasn’t viable. They knew that, going in. The issue was negotiating supply from EBMUD and others” who “couldn’t guarantee any water.”
He also spoke about future supply including the proposed offstream Sites Reservoir project west of Colusa in the Sacramento Valley.
“In California, for every one million acre-feet of storage, there is eight to nine acre-feet of surface storage,” Avila stated.
Finally, in response to a question, he said, “Water from a canal behind a house is not grandfathered in if the home is sold.”
The next CoCoTax Members and Board Luncheon will be held on Friday June 27, 2025, at 11:45 AM at Denny’s Restaurant, 1313 Willow Pass Road in Concord, and will feature Oakland Mayor recall leader Seneca Scott as the speaker. Advance registration is available on the CoCoTax website where you can pay online, or bring cash or check on Friday and pay at the door: $25 for members, $30 for guests. www.cocotax.org/event-6189658/Registration
About CoCoTax
Founded in 1937, CoCoTax leads the way in providing fiscal oversight of local government. We actively resist unwarranted taxes and fees, discriminatory regulations, ill-advised public expenditures and government secrecy, inefficiency and waste. For more information and membership visit www.cocotax.org.
About CCWD
The Contra Costa Water District delivers safe, clean water to approximately 520,000 people in central and eastern Contra Costa County in Northern California. Formed in 1936 to provide water for irrigation and industry, we are now one of the largest urban water districts in California and a leader in drinking-water treatment technology and source water protection. For more information visit www.ccwater.com.
Will fund conversion of Comfort Inn to rehabilitation project
City commitment required for state funded operating subsidy
By Allen D. Payton
The Antioch City Council will hold another special meeting on Thursday, May 22, 2025. This one will be for discussing a financial commitment for the state’s Homekey+ Program to serve the city’s homeless residents. The matter is time sensitive as the State begins its Award Announcements this month. The meeting begins at 6:30 p.m.
NOFA means Notice of Funds Availability. Source: CA Dept of Housing and Community Development
According to the City staff report for the one-item agenda, “It is recommended that the City Council adopt a resolution approving the submission of an application with California Supportive Housing for the Homekey+ Program and designate City Manager to execute commitments for city capital match up to $750,000 and operating subsidy up to $1,200,000 annually for 5 years with two five year extensions contingent on the property meeting the required Homekey+ guidelines and affordable housing regulatory agreement and authorizing the City Manager or designee to execute the Agreement in a form approved by the City Attorney.”
Will Fund Conversion of Comfort Inn to Rehabilitation Project
“The City Staff is proposing a co-application with the Developer that seeks funding to acquire 2436 Mahogany Way (currently the Comfort Inn) in Antioch and undertake the rehabilitation necessary for the motel rooms to serve as permanent housing for homeless families/individuals with prior behavioral health issues.
“The CSH Mahagony Housing Project will be a rehabilitation project which will turn the current hotel into 60-85 affordable units and one two-bedroom manager unit. Each apartment will have a kitchenette, living room, bathroom, and bedroom. Non-residential conversion of the interior will include a community lounge, property management offices, resident supportive services and case management offices. One existing laundry room and the electrical room will maintain those functions, while rooms will be converted to resident services/case management and property management offices. It is also planned to keep the existing security fences, gates, and trash enclosure. Additional fencing will be added to property.
“Project Developer: California Supportive Housing (CSH) is the Project Developer. CSH is a mission-oriented 501 (c)(3) nonprofit California corporation dedicated to bringing affordable housing to people in need, including homeless, seniors, youth, people with disabilities, and families. The CSH team has over 35 years of experience in affordable housing development and is currently working on a HomeKey project in Oakland which is the conversion and renovation of a motel into 104 permanent supportive housing units for the homeless.”
About Homekey+ Program
According to the California Department of Housing and Community Development (HCD), the state’s Homekey+ Program is funded by Proposition 1, which was “passed by California voters in March 2024…to reduce homelessness and protect our most vulnerable populations through important changes to the Mental Health Services Act and providing up to $6.4 billion in bond funding to develop and expand behavioral health treatment, residential care settings, and Permanent Supportive Housing.”
“Approximately $2 billion of the Proposition 1 bond funds will be administered by the…HCD, in collaboration with the California Department of Veterans Affairs (CalVet) as the Homekey+ program (HK+), expanding upon the successful Homekey model. The remaining $4.4 billion of the Proposition 1 funding will be administered by the California Department of Health Care Services (DHCS) to award competitive grants to construct, acquire, and rehabilitate real estate assets or invest in needed infrastructure to expand the behavioral health continuum of treatment and service resources.”
